RT-PCR检测肾移植术后血浆、尿及白细胞中巨细胞病毒感染的临床意义

Clinical significance of RT-PCR in determination of cytomegalovirus in urine,plasma and leukocyte in renal transplant recipients

目的比较RTPCR连续动态监测肾移植患者血、尿及白细胞中巨细胞病毒(CMV)载量的临床意义。方法接受同种异体肾移植的患者共56例,应用RTPCR动态监测血、尿及白细胞中CMVDNA载量,比较三类标本检测的阳性率、病毒载量的变化以及与CMV肺炎的相关性。结果血浆、尿液和白细胞中的检出率分别为85.7%、87.5%和92.5%。采用术后第5～15周内连续三次病毒载量大于104拷贝/ml作为预测CMV肺炎的指标,三类标本均有令人满意的灵敏度、特异度、阳性和阴性预测值。尿液检测的灵敏度最高,白细胞的Kappa一致性最优,预警时间以尿标本为最佳。结论连续动态监测病毒载量是临床上预警CMV肺炎的有效手段,血浆、尿液和白细胞这三类标本均有独立价值。

Objective To compare the clinical significance of dynamic surveillance of CMV-DNA in urine, plasma and leukocyte in renal transplant recipients by RT-PCR. Methods CMV-DNA in urine, plasma and leukocyte was dynamically determined in 56 renal transplant patients by RT- PCR,and the positive rate, variation of viral load and the relativity with CMV interstitial pneumonia （CMV-IP） were compared. Results Positive rates of CMV-DNA in urine,plasma and leukocyte were 87. 5%, 85.7% and 92.5%, respectively. The sensitivity, specificity, positive and negative predictive level of the three specimens were all satisfactory when viral load over 10^4 copy/ml for continuous three weeks was used as a predictive index. Urine sample had the highest sensitivity,and leukocyte sample had the most excellent kappa coherence. The prealarm time of urine sample was the best. Condusion Each of the three specimens owns independent value in predicting CMV-IP after renal transplantation.